Makindo Medical Notes

Related Subjects: |Brain tumour s |Astrocytomas |Brain Metastases

🧠 Superior Sagittal Sinus Thrombosis (SSST) is a rare but important cause of stroke-like presentations, seizures, or unexplained headaches. A high index of suspicion is crucial, especially in young women with risk factors. 🚨

📌 About

• SSST = clot formation in the superior sagittal sinus, the main venous drainage channel of the brain.
• Presents variably → can mimic stroke, epilepsy, or encephalopathy.
• Early diagnosis is vital as treatment dramatically improves outcome.

⚠️ Aetiology

• More common in 👩 young females, esp. during pregnancy, puerperium, or OCP use.
• Underlying thrombophilia (e.g. Factor V Leiden, antiphospholipid syndrome).
• Other causes: dehydration, local infections (sinusitis, otitis), head trauma, malignancy.

🩺 Symptoms & Signs

• 💢 Headache: Severe, progressive, sometimes positional.
• ⚡ Seizures: Focal or generalized (often new onset in young adults).
• 🌀 Altered consciousness: Confusion → drowsiness → coma in severe cases.
• 🧑‍⚕️ Stroke-like deficits: Hemiparesis, aphasia, or visual field defects (but atypical for arterial stroke pattern).
• 🌟 Papilloedema: May be seen due to raised intracranial pressure (ICP).

🔬 Investigations

• Bloods:
  • FBC (polycythaemia, infection).
  • U&E (dehydration), ESR/CRP (inflammation).
• CT Brain:
  • May be normal in early stages.
  • Delta sign (triangular filling defect) can be seen in posterior sagittal sinus.
  • May show venous infarct ± haemorrhage.
• 🧲 MR Venography (MRV): Gold standard → filling defect in superior sagittal sinus.
• 🧬 Thrombophilia screen: Factor V Leiden, prothrombin mutation, antiphospholipid antibodies.
• Malignancy screen: CT CAP, mammography, etc. if risk factors present.

💊 Management

• 🩸 Anticoagulation: IV unfractionated heparin or LMWH even if haemorrhagic transformation present. Improves survival and outcome.
• 🧪 Catheter-directed thrombolysis: Considered in refractory cases with severe deficits.
• 📆 Long-term anticoagulation: Warfarin or DOACs for 3–12 months depending on risk factors.
• 💊 Steroids: ❌ Not recommended (no proven benefit).
• ICP management if raised (head elevation, osmotic therapy, ICU monitoring).

📉 Prognosis

• With prompt anticoagulation → good recovery in most cases.
• Delayed diagnosis → risk of permanent disability or death.
• Recurrence risk higher in those with uncorrected thrombophilia.